East Midlands
Referrals

222 Nottingham Rd, Hucknall, Nottingham NG15 7QD

Phone : 0115 9274458

Monday - Friday 08.30 - 19.00
+ Emergency out of hours service

Corrective Joint Surgery

Cruciate ligament failure

corrective-joint-surgeryWe treat hundreds of cases annually, almost all surgically. There are a bewildering array of options (even from a veterinary perspective!) with nearly seventy different techniques having been devised since the 1950’s. These fall into 3 groups;

  • Replacing the ligament with a biological tissue (grafting)
  • Replacing or mimicking the function of the ligament with synthetic materials (imbrications and direct replacements)
  • Re-engineering the joint so that it will function well without a cranial cruciate ligament (osteotomies)


Over the last 10 years the options have generally crystallised into either the second or the third group with biological grafts becoming infrequently performed (although still used in the human field).

The second group can be split into 2 categories,

  • Lateral suture systems / lateral retinacular imbrication
  • Tightrope suture system


The latter is more recent and has advantages in larger patients since in almost all cases with these techniques the synthetic material will fail over time and success may be chiefly reliant on the biological reaction to generate supporting scar tissue.

The third group, the osteotomies (bone cutting operations), stemmed from work by Barclay Slocum (now deceased) in the United States during the late eighties. This represented a radical lateral re-thinking of this problem and it’s treatment and has given rise to many other osteotomies (TTA, tibial wedge osteotomy and TTO). These procedures do not rely on repair or replacement of the ligament but on altering the internal angles of the joint to re-orientate the forces acting on it and effectively render the failed ligament redundant. These are the most frequently performed surgeries in referral (specialist or second opinion) practices.

This clinic uses either TTO (devised by Warwick Bruce, Sydney university) or TTA in larger breed patients or TWO (tibial wedge osteotomy) in very small patients. These operations are more complex and costly than alternatives but it has become clear that they provide much more rapid recovery helping to maintain joint mobility and limb strength as a result. After a period of scepticism (some years ago) there is no doubt that, for many of our patients, this approach gives far superior results.

Meniscal injury

Frequently associated with cruciate ligament failure we find meniscal tears. The menisci are two small cartilage bodies in the knee (in man, commonly referred to as cartilages – torn in rugby football and squash) they are tangerine segment shaped but more 'c' shaped. Treating cruciate ligament injuries without addressing meniscal tears is of very limited value and can hinder their later treatment. We diagnose and treat these injuries with keyhole procedures.

Patella luxation (dislocating knee caps)

This is very common in smaller terrier breeds and more often now in select larger breeds (labrador, for example). There are a number of techniques for correction, including transplanting the attachment of ligaments, deepening the groove it runs in and adjusting tension on the ligaments that pull it to either side. In larger dogs, sometimes a deviation in the end of the femur (thigh bone) needs to be straightened by a more complex procedure.